The Roux-en-Y Gastric Bypass is considered the "gold standard" of bariatric surgical procedures, and it is the most commonly performed weight-loss operation in the United States. It has the most proven, long-term results compared with other bariatric procedures, because the effects have been documented for more than 20 years. Roughly 70 percent of American weight-loss surgeons use it as their primary weight loss operation.
The Roux-en-Y Gastric Bypass is a combined restrictive/malabsorptive operation, which restricts both food intake and the amount of calories and nutrients the body absorbs.
During this procedure, the stomach is partitioned with a stapler, creating a small pouch (15mls), and stomach capacity is reduced from the size of a football to the size of an egg. This smaller capacity produces a feeling of fullness with small amounts of food.
Next, the pouch is connected to a Y-shaped section of the small intestine (called the Roux limb), allowing food to bypass the lower stomach and the first two parts of the small intestine. Because of this, food bypasses most of the stomach and duodenum and empties directly into the Roux limb. Most patients do not experience significant malabsorption of food. The ability to consume fluids is not affected, as liquids pass through the pouch very quickly.
The operation can be performed either laparoscopically, through five or six very small incisions in the abdominal wall, or open, through a traditional midline abdominal incision. In general, Dr. Lord prefers the laparoscopic approach because of its many patient benefits, including decreased pain, faster recovery, quicker return to normal activities, and a lower incidence of incision-related problems like infection or hernia.
• Weight loss ranges from 60 to 80 percent of excess body weight within two years.
• Most co-morbidities such as diabetes, high blood pressure, sleep apnea and high cholesterol improve after the surgery, and some are even cured.
• Roux-en-Y surgery is generally safe, but it can lead to serious and potentially fatal complications. In a gastric bypass, the stomach and intestines are cut and then reconnected using staples and stitches, which have the potential to tear in the first few weeks after surgery. This can lead to peritonitis and bleeding.
• Intestinal blockage, due to scar tissue or intestinal twisting, is a possibility.
• After two years, some patients regain 10 to 30 pounds of weight they previously lost due to stretching of the pouch and its outlet. This results in return of appetite and loss of fullness.
• The Roux-en-Y operation causes food to bypass areas of the small intestine that are responsible for absorbing protein, calcium, and certain vitamins. In addition, less iron is absorbed because of the small size of the new stomach pouch. To avoid nutritional deficiencies, you will need to take daily vitamin and mineral supplements every day for the rest of your life.
Laparoscopic Sleeve Gastrectomy Gastric sleeve surgery (also known as gastrectomy) is a weight loss procedure that purposely restricts the amount of food that you can eat because you feel full more quickly.
In this procedure, a thin, vertical sleeve of stomach (approximately eight inches long) is created using a stapling device and the rest of the stomach is removed. Food passes through the digestive tract as usual and is fully absorbed into the body.
Patients who have elected this approach have been shown to experience significant weight loss and improvements in their health. Weight loss outcomes are comparable to gastric bypass.
Laparoscopic Adjustable Banding (Lap-Band)
Adjustable Gastric Banding (Lap-Band) The second, newer approach performed at Sacred Heart is adjustable gastric banding or Lap-Band. Lap-Band surgery is a "restrictive" operation, which means that it limits food intake and does not interfere with the normal digestive process.
Using a laparoscope, the surgeon places an inflatable band around the stomach, creating a small upper pouch at the top, with restricted passage to the rest of the stomach. This pouch fills quickly and creates a feeling of fullness. The band is adjustable by injecting saline into a small port placed underneath the skin, so that the band can be tightened or loosened over time depending on the progress and needs of the patient. This is accomplished by using a fine needle to gain access to a small reservoir that is positioned well under the skin and fat of the abdomen at the time of surgery. The reservoir, in turn, is connected by a thin tube to the saline-filled band. It is not visible from the outside, and it can be felt only when you push on your abdomen.
At first, the pouch holds about 1 ounce of food, and later may stretch to 2-3 ounces. The lower outlet of the pouch is usually about ½-inch in diameter or smaller. This small outlet delays the emptying of food from the pouch into the larger part of the stomach and causes a feeling of fullness.
After the operation, patients can no longer eat large amounts of food at one time. Most patients can eat about ½ to 1 cup of food without discomfort or nausea, but the food has to be soft, moist, and chewed well. As with any bariatric surgery, to be successful long-term, patients must be compliant with proper eating.
• Gastric banding is the safest form of bariatric surgery, with a rapid recovery time.
• Weight loss ranges from 50 to 65 percent of excess body weight during the first two years, and it is maintained for up to five years.
• It is the least-invasive operation of all the weight loss surgeries available. Since there is no cutting or re-connecting of stomach or intestines, there is no risk of intestinal leak, dumping syndrome, or food intolerance.
• Patients who have the Lap-Band do not feel hungry, most likely because a small amount of food stretches the uppermost part of the stomach, signaling a sense of fullness.
• There is no malabsorption of medication or protein, which means that you absorb every nutrient that you eat. This is particularly important in young women who want to get pregnant.
• The majority of existing obesity-related health problems are improved, or even cured, such as diabetes, high blood pressure, sleep apnea and high cholesterol.
• Since the band is an implantable device, its effect can be completely reversed just by taking it out.
• The surgery takes approximately one hour to perform and requires only an overnight hospital stay. Patients can return to work in three to five days.
• It is adjustable - without the need for more surgery – with just a ten minute visit to the surgeon's office. As you lose weight, the band needs to be tightened every six to eight weeks. You will need to see your surgeon frequently during your first year after surgery, and then once annually thereafter to ensure that everything is working properly. Sometimes, if you are pregnant or become ill, you may need to have the band loosened to allow you to eat more.
• You must re-learn how to eat. If you eat too fast or too much, or if you don't chew your food enough, you will get sick. Some foods - such as steak, white meat chicken, and doughy bread - will not pass through the opening.
• Weight loss is slower, with 70 percent of patients achieving significant weight loss. Your success depends on your commitment to keeping follow-up visits with your surgeon every six to eight weeks for at least the first year and perhaps longer to have your band adjusted. If you do not follow-up with your surgeon, you will not lose weight.
• Because the Lap-Band is an implantable device, it does carry a small risk of slippage or erosion into the stomach. In either case, another laparoscopic surgery would be required to re-position or remove the band.
• Other technical problems can arise. In a few cases, the tube may kink or the reservoir may twist, which may require minor surgery.
• The Lap-Band is not a perfect solution, and it will not result in weight loss if you start eating an excess amount of chocolate or high-calorie drinks, such as ice cream, milk shakes and soda.
Revisional Surgery What is Revisional Bariatric Surgery? In some instances, patients may need another surgery to revise a previous bariatric surgery. This usually occurs for those patients who may have had an outmoded operation performed many years ago. In the past, many patients underwent "stomach stapling," another term for the Vertical Banded Gastroplasty, or VBG.
Although this operation may work for some individuals, a large proportion of VBG patients do not lose as much weight as they would like to, and they may experience unpleasant side effects such as excessive vomiting.
A VBG procedure may be converted to a gastric bypass, and it can be performed open, laparoscopically, or orally with the new StomaphyX procedure.
Traditional Revision Surgery Traditional revision surgery is performed using the Roux-en-Y gastric bypass technique, the “gold standard” of bariatric surgery. It can be performed open or laparoscopically. It is important to understand that any revisional procedure is a very major operation, with risks that are greater than for a primary procedure. Nonetheless, many patients may benefit substantially from a conversion of their VBG.
StomaphyX Revision Surgery The StomaphyX procedure is a new, endoscopic bariatric surgery technique that was approved by the FDA in 2007. It helps to further shrink the size of the stomach. When compared to traditional revisional bariatric surgery, the new technique provides advantages such as no incisions or scars, less pain, a lower rate of complications, little or no hospital stay and a much quicker recovery.
During the procedure, a flexible endoscope is passed through the mouth and advanced into the stomach, carrying a fiber-optic camera and a tubular surgical tool. Stomach tissue is then pulled by suction into the tubular device and 10 to 20 fasteners are placed strategically into the inside lining of the stomach, creating pleats in the tissue and reducing the size of the stomach’s pouch. The smaller stomach capacity allows the patient to feel full and satisfied with less food, promoting further weight loss.
Patients should expect to experience some discomfort in their chest, nose, and/or throat for the first few days to a week after the procedure. *Physical activity should be restricted for a week and appropriate dietary guidelines will be given to maximize success.
Please note: Most insurance policies do not cover the StomaphyX procedure at this time.